Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.
A new study examines the implications of the nearly two-fold regional differences in per-capita Medicare spending observed across the United States. The researchers studied four groups: patients with heart attacks, colorectal cancer, hip fracture, and a general population sample (Articles, p. 273 and p. 288). In each group, patients living in higher-spending regions received about 60 percent more care than those in lower-spending regions, even though their needs for care were nearly identical. The increased spending was largely due to greater use of the hospital, diagnostic tests, and referral to specialists. Those in higher-spending regions, however, had no better access to care, were no more likely to get major surgery, and were less likely to receive certain preventive services. Quality of care, long-term survival, functional status and satisfaction with care were no better in higher-spending regions. The authors observe that if higher spending regions could safely achieve the more conservative practice patterns of the lower cost regions, savings of up to 30 percent of Medicare spending might be possible. The articles are accompanied by three editorials (p. 347, p. 348, p. 350) and are also featured in a video news release; call for coordinates.
(Perspective, p. 335)
Chronic hepatitis C virus (HCV) may slowly progress to cirrhosis, scar tissue in the liver and a major risk factor for liver cancer. Interferon therapy has been used successfully to treat chronic HCV. A small, randomized, controlled study of 74 liver cancer patients with mild HCV and mild cirrhosis suggests that removing liver tumors by ethanol injection therapy, followed by interferon therapy to treat the HCV, may reduce the risk of tumor recurrence (Article, p. 299).